“Mixed Bag” is a series where I ask a guest to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item, they have to explain why they selected it and what it signifies. — Awais Aftab
Dr. Rosa Ritunnano is Senior Clinical Research Fellow (University of Birmingham), Hon. Research Fellow (University of Melbourne) and Consultant Psychiatrist in Early Intervention for Psychosis Services in the UK. She is an internationally recognized, early-career scholar in the area of phenomenological psychiatry and qualitative and philosophically-informed research in mental health. Her work has been profiled in The Lancet, where she was recognized as a “rising star” and “champion of phenomenology in psychiatry.” She completed her PhD in 2025 on the topic of “Delusions and Meaning,” which was awarded a Dean’s Award for Excellence in the PhD Thesis by the University of Melbourne.
Introduction
Having followed Awais’s work for some time, and being not-so-secretly an ardent admirer of his uncompromisingly nuanced and intellectually generous contributions to the philosophy of psychiatry, I’m particularly delighted to contribute to the Mixed Bag series. It came as an opportunity for me to reflect on some of the ideas, people, and works that have shaped my own thinking, especially during the final phase of my PhD, and whose influence has continued to unfold well beyond it.
Since my first day as a psychiatry trainee, I have never been comfortable with the individualistic, inward-looking and neurocentric biases that continue to shape psychiatric approaches to psychopathology. One assumption that I find particularly pernicious, and that I believe has led the field astray, is the idea that delusions are to ideation what hallucinations are to perception.
Part of what troubles me about this assumption is that it seems to leave very little room for the emotional life of the person experiencing psychosis. It encourages us to approach delusions primarily as cognitive ‘errors,’ as though their meaning could be understood independently of the feelings, relationships and circumstances in which they take shape. Yet, it is because we feel, because we are moved, that life, and the world around us, have meaning. Shame can make the world feel exposing and judgmental; fear can transform otherwise familiar surroundings into “enemy’s territory”; love can make the future appear full of exciting possibilities. These transformations are recognizably human ways of being in the world. And the lives of people experiencing psychosis are no less human than anyone else’s. Their emotional worlds, however unfamiliar or difficult to understand, deserve to be taken just as seriously as those of anyone else. But when someone experiences psychosis, we tend to question the reality of their experiences more than we attend to the reality of their emotional lives. What might we discover if we approached delusions as genuine testimonies of people trying to make sense of profound and disorienting experiences? What if the intense emotions people describe were not merely consequences of a disrupted sense of self, but integral to psychosis itself? These questions invite us to rethink both how we understand psychosis and how we respond to those who experience it.
Book — Robert C. Solomon, The Passions: Emotions and the Meaning of Life (1976/1993)
This was a difficult one to pick, and Hartmut Rosa’s Resonance has been a close contender, but I decided to go with Robert Solomon’s The Passion: Emotions and the Meaning of Life, which became an inseparable companion towards the end of my PhD. It might seem an unusual choice for someone researching delusions, but emotions have become central to how I think about the experiences of people living through delusions, and this is where my thinking about them began.
Someone once told me that there are four emotions in psychiatry: anxiety, depression, euthymia, and elation. And two moods: high and low. And I suspect I’m not the only psychiatrist who will recognize something of this caricature in their clinical training... We learn to identify, assess and classify states that are deeply affective in nature: anguish, despair, extreme self-dislike and reproach, self-aggrandizement, dread, euphoria. Yet, there is comparatively little opportunity to engage deeply with the philosophy of emotions: what emotions are, how they shape our experience of the world, and what they tell us about who we are.
Solomon’s work is, at least to my mind, a fairly rare kind of philosophical text, one that manages to be rigorous and systematic without ever losing its wit and humor. And there is definitely a phenomenological sensibility to it, but without the jargon that can sometimes make phenomenology such hard work.
Solomon’s thesis is clear from the Introduction:
“Emotions are said to distort our reality; I argue that they are responsible for it. Emotions are said to divide us from our interests and lead us astray; I argue that emotions create our interests and our purposes. The emotions and consequently the passions in general are our reasons in life. What is called “reason” is the passion enlightened, “illuminated” by reflection and supported by a perspicacious deliberation that the emotions in their urgency normally exclude. It is our passions, not our reason (and surely not “nature”), that constitute our world, our relationships with other people and, consequently, our Selves.” (p. 15).
Reading Solomon shifted my perspective as I wrestled with the relationship between emotion and cognition in what we call ‘delusional’ thought. If, on Solomon’s view, our emotions constitute our worlds (and arguably our selves) rather than merely ‘coloring’ our perceptions, what might this mean for our understanding of delusional thought (and reality)? What if we approached delusions not simply as symptoms to be measured or managed, or as false beliefs to be corrected, but as extraordinary, yet recognizably human, ways of being affectively involved in the world?
Fear, shame, love, awe or anger are not merely internal states (I should probably mention here Edward Casey’s book Turning Emotion Inside Out as a particularly relevant reference, though this is a thesis broadly compatible with phenomenological and enactive approaches). Fear, for instance, is not merely an internal feeling; it involves experiencing something as threatening. Shame involves experiencing oneself as exposed to the judgment of others, while awe can transform one’s sense of being in close relationship with the world. In this sense, emotions shape what stands out as significant, how other people appear to us, what feels possible, desirable, or threatening, and who we understand ourselves to be. They can alter not just what we believe about the world, but the very character of the world we inhabit.
For Solomon, each emotion also has its own logic, even an ideology that makes demands about “how the world ought to be”:
“It is not only an interpretation of our world but a projection into its future, filled with desires which sometimes become intentions and commitments. Our anger demands that the offender be punished; our love requires the effort of intimacy […] Embarrassment wants to hide, jealousy to retrieve, hatred to hurt […].” (p. 220)
But the object of any single emotion, Solomon suggests, usually belongs to a much more extensive system of interconnected objects, which permeate a particular realm of our experience and make it meaningful. He calls this a “mythology”: an understanding of the world that is neither literally true nor false in the straightforward sense of an explanation, because it is concerned less with explaining the world than with interpreting it.
Although my phenomenological background had always drawn me in this direction, Solomon pushed me further to think about delusions in affective, and goal-directed, terms: not merely in terms of the propositional content of a person’s beliefs but in terms of how a particular understanding of reality takes shape in one’s life, through certain emotions and desires that make it especially meaningful, compelling and difficult to relinquish.
Concept – Disorientation
I first came across the concept of disorientation when I found a reference to Amy Harbin’s book Disorientation and Moral Life in a paper by Matthew Ratcliffe and Eleanor Byrne (2022) on grief, self and narrative. In this paper, the authors make use of the concept to capture the manner in which grief does not simply entail moving from a time-before (A) to a time-after (B), but also involves inhabiting, for some time at least, a place and time in-between A and B—a world where the person is no longer there, yet they are still central in how we experience and think about the world and ourselves. In a world so constructed, we may feel “disoriented”: the world we have always known is still there, but something fundamental has changed, making it difficult to know how to live in it. This creates a tension of sorts, so that we find it difficult to know how to go on. In Harbin’s own words, disorientations are “sustained periods of life when we are coping with having been blindsided by major events. […] to be disoriented feels like one loses one’s footing and is adrift in deep, unpredictable waters. In many such cases, it seems impossible that life will go on.” Beyond grief, disorientations can also occur in the context of many other kinds of life-altering events.
This concept became particularly helpful for me, and still is, in the process of making sense of ‘delusional’ narratives—narratives told by people whose testimony would be met by others with a degree of bafflement or unease, and would likely be attributed ‘pathological’ status. Now, as clinicians, we are trained to recognize the ‘delusionality’ in delusional narratives—what, to our ear, rings untrue, unusual or supposedly illogical. But what we forget in the process is that what we call a ‘delusion’ is, first, a form of testimony: an attempt to communicate something about how a person experiences and makes sense of the world, always within the context of a relationship with a listener, usually mediated by linguistic discourse.
Discourse is often propositional, but not always; for instance, it may express or enact something like feelings, moods, or embodied states. And the uttering subject surely didn’t set out to utter ‘a delusion’ as such (at least not that they knew of). More likely, they were trying to articulate their own understanding of the world as they experienced it, at that particular moment in their life. There may be irrational beliefs woven into the story they tell (the opposite would be surprising, unless we are talking about Star Trek’s Mr Spock), but they are not the whole story. They are situated within it. It is only in this particular context that certain beliefs, along with other elements of discourse, acquire their meaning: that they begin to add up to something the speaker is trying to articulate.
This became clear as I analyzed interviews with people who had experienced delusions in the context of psychosis during my PhD. What I found were not neat, ready-made delusional beliefs of the kind often discussed in philosophical texts, but unfolding life narratives rich in emotional and relational detail. These were often stories of profound disorientation—breakups, humiliation, grief, unrequited love, shame and loneliness—accompanied by a powerful desire to rebuild loving relationships and find a sense of direction and possibility for the future.
Thinking about delusions through the lens of ‘disorientation’ opens up the possibility that they are doing some kind of expressive, affective or existential work. This is difficult to see if we focus exclusively on the ‘erroneous’ content of beliefs, rather than on the lives in which they take shape.
Person— Lorna Collins
I haven’t known Lorna for very long, but I felt an immediate connection with her and her work since we started our online exchanges a couple of years ago. Perhaps it is because so much of what she writes about resonates with questions that have shaped my own research: how we make sense of experiences that can seem incomprehensible to others, and what happens when the language we use to describe someone’s distress gets in the way of understanding what they are trying to convey. Her writing cuts right through the distance between clinical knowledge and lived experience. As she puts it, “it’s complicated”.
“I hear loud reverberations from mad voices, responding to overbearing laws from sane, ableised norms. I hear distrust and dismay from their voices, who are disdained. There is much work to do here, for a more tolerant, accepting and creative (not coercive) society, where all minds and all bodies play their part. […] What I am not hearing (enough) are the voices of people who have experienced an acquired brain injury or a neurological condition. Are we mad? If we are, is that a slur, or an unnecessary categorisation, or a compliment? It is complicated.” (https://lornacollins.com/)
In an essay recently published in The Lancet Psychiatry, Lorna describes how a crisis led her through repeated assessments, transfers between services and detention under the Mental Health Act. Although clinicians spoke of choice and shared decision-making, she felt that, in practice, “at every station, choice disappeared.” The almost exclusive focus on medication by her treating team, left her feeling unheard and unseen. What she needed was practical, relational and creative support: “someone to help me face one impossible sensation at a time”.
Lorna’s account is a powerful reminder that we can be right about the treatment someone needs and still fail to find a way of helping them receive it. This is not an argument against medication, but a challenge to a model of care in which treating symptoms can become detached from understanding the person experiencing them. As clinicians, how can we reach someone not only ‘in terms they can tolerate’, but in ways that make them feel sufficiently safe, heard and understood to enable them to articulate what they are really trying to tell us? For me, phenomenology is part of the answer.
Article — Rethinking Psychosis Through Affect: Towards a Phenomenology of Emotional Consciousness (Ritunnano, Pienkos & Paranamana, forthcoming)
I’m going to do something a bit cheeky here and pick an article of my own, co-authored with my friend and colleague Liz Pienkos and with Nadi Paranamana. At the time of writing, the article is forthcoming in a special issue of the open-access journal Philosophy and the Mind Sciences, so this is a bit of a preview. I’m biased of course, but I think it’s a fairly bold paper, where some inchoate ideas that have been brewing for some time, finally take shape and (we hope) push the field forward beyond more classical phenomenological accounts of schizophrenia-spectrum disorders.
One idea that has dominated the phenomenological psychopathology literature over the past 20 years, is that articulated in the so-called ‘ipseity-disturbance’ or basic self-disturbance model of schizophrenia, initially proposed by Joseph Parnas and Louis Sass (2003) and then subjected to some critiques, re-elaborations and revisions over the years (most recently in Feyaerts & Sass, 2024).
In brief, the central idea is that schizophrenia involves, at its core, a disturbance of the minimal or basic sense of self: the structure that gives experience its immediate first-person character, its being experienced as I, me, myself, mine, my own. In the classical version of the theory, this disturbance of the basic sense of self is understood as a persistent feature of the disorder. It is thought not only to help predict and identify schizophrenia, but also to explain a remarkably wide range of experiences associated with it, including some that may seem very different, or even contradictory. (This obviously begs the much bigger question of whether we can even speak of a unitary disorder in the first place, but I won’t venture into that here.)
As a clinician working with people experiencing psychosis, and witnessing the evolution of their difficulties in the first few years after onset, what has always surprised me is the relatively little attention paid to the deeply affective situations people describe finding themselves in: profound grief over unrequited love, unbearable humiliation and shame over the kind of person one is portrayed to be, self-righteous anger at a world that doesn’t obey our expectations, ecstatic and blissful unity in a world permeated by the loving presence of God.
This is quite different from the experiences often described as central to self-disorders: inability to feel emotions, loss of vitality, or a sense of detachment from one’s own body and the social world around us. But even where dissociative processes are at play, can we simply dismiss affect as a mere byproduct of the illness? Or should we think more deeply about its role in the development and maintenance of the ways of being, and relating to oneself and others, that people experience as current realities—ways that may be more or less maladaptive, distressing or, indeed, meaningful?
In the paper, we argue that emotions are neither simply a byproduct of an underlying disturbance in the sense of self, nor merely external influences that modulate otherwise unrelated changes in perception and thought.
Rather, we want to suggest that emotions directly shape what these experiences are like in the first place: the world appears as threatening, loving, or otherwise meaningful because of the emotions through which we experience it. This includes how emotions are felt in the body, how they move us to act, what we come to value, and the stories we construct to make sense of what is happening to us.
I hope I’ve now convinced you to look out for its publication and put it at the top of your reading list!
Surprise item — Brooke Shaden
I want to mention the work of artist and photographer Brooke Shaden. I first heard about her through a friend and fellow phenomenologist, Valeria Bizzari, who introduced me to her work, and then contacted her asking if I could use her artwork for a conference presentation I was giving.
What fascinates me about her surreal, dreamlike self-portraits is their ability to evoke experiences that can be extraordinarily difficult to put into words. In my work, I am particularly interested in how some delusional experiences involve profound alterations in the experience of one’s own body and one’s relationship with the world. In ordinary interactions, we tend to take for granted that we inhabit a shared reality, governed by familiar assumptions about time, space, causality, and what is real. But what happens when these assumptions no longer hold? How do we even start talking about an experience when the very world in which it unfolds has become terrifyingly unfamiliar to us? I think Shaden’s images bring these questions to the foreground in ways that language alone cannot. They don’t offer a literal representation of what someone experiences in psychosis, of course, but they can invite us to suspend our everyday assumptions for a moment and imagine what it might be like to inhabit a different experiential world.
I was also struck by Shaden’s fearless determination to get close to the very things that frighten her like grief, death and mortality. As she describes it, getting closer to what she fears gives it less power over her. Perhaps this is another reason why her work resonates: it invites us to get closer to experiences that might otherwise feel too strange, unsettling or difficult to contemplate, and to stay with them long enough to discover recognizably human emotions and concerns that we can all relate to.
See previous posts in the “Mixed Bag” series.
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